Electrocardiogram Patterns during Hemodynamic Instability in Patients with Acute Pulmonary Embolism

Background We have previously described new electrocardiogram (ECG) findings for massive pulmonary embolism, namely ST‐segment elevation in lead aVR with ST‐segment depression in leads I and V4–V6. However, the ECG patterns of patients with acute pulmonary embolism during hemodynamic instability are...

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Bibliographic Details
Published in:Annals of noninvasive electrocardiology 2014-11, Vol.19 (6), p.543-551
Main Authors: Zhan, Zhong-qun, Wang, Chong-quan, Nikus, Kjell C., He, Chao-rong, Wang, Jin, Mao, Shan, Dong, Xiong-jian
Format: Article
Language:English
Subjects:
Acute Disease
acute pulmonary embolism
electrocardiogram
Electrocardiography
Electrocardiography - methods
Embolisms
Female
Heart attacks
hemodynamic instability
Hemodynamics - physiology
Humans
Hypotension - complications
Hypotension - physiopathology
Male
Medical research
Middle Aged
myocardial ischemia
Myocardial Ischemia - complications
Myocardial Ischemia - diagnosis
Myocardial Ischemia - physiopathology
Original
Pulmonary Embolism - complications
Pulmonary Embolism - physiopathology
right ventricular strain
Shock, Cardiogenic - complications
Shock, Cardiogenic - physiopathology
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Summary:Background We have previously described new electrocardiogram (ECG) findings for massive pulmonary embolism, namely ST‐segment elevation in lead aVR with ST‐segment depression in leads I and V4–V6. However, the ECG patterns of patients with acute pulmonary embolism during hemodynamic instability are not fully described. Methods We compared the differences between the ECG at baseline and after deterioration during hemodynamic instability in twenty patients with acute pulmonary embolism. Results Compared with the ECG at baseline, three ischemic ECG patterns were found during clinical deterioration with hemodynamic instability: ST‐segment elevation in lead aVR with concomitant ST‐segment depression in leads I and V4–V6, ST‐segment elevation in leads V1–V3/V4, and ST‐segment elevation in leads III and/or V1/V2 with concomitant ST‐segment depression in leads V4/V5–V6. Ischemic ECG patterns with concomitant S1Q3 and/or abnormal QRS morphology in lead V1 were more common (90%) during hemodynamic instability than at baseline (5%) (P = 0.001). Conclusions Hemodynamic instability in acute pulmonary embolism is reflected by signs of myocardial ischemia combined with the right ventricular strain pattern in the 12‐lead ECG
ISSN:1082-720X
1542-474X
DOI:10.1111/anec.12163